Georgia senator urges reining in Medicaid, Medicare 'super utilizers'

Government and business reporter

State Sen. Renee Unterman warned Thursday of the weight “super utilizers” put on the Georgia health system and the need to spread government money more efficiently.

This group of Georgians — those who are both Medicaid and Medicare eligible and often with chronic, long-term health care needs — makes up a minority of those on the government programs, but account for much of the spending.

The numbers Unterman used, though she cautioned she didn’t have her notes to provide specifics, figures that about 15 percent of Medicaid recipients account for about 43 percent of spending.

“If we do not rein in the dual eligibles in the state of Georgia, in all of the states of the nation, we are in serious, serious trouble,” she told attendees to the State of Public Health conference in Athens. The conference was organized by the University of Georgia College of Public Health.

Unterman, R-Buford, a former trauma nurse, said she wasn’t advocating booting them off the system, but for a more efficient use of dollars to better serve them and others that rely on the services. Many of these super utilizers will require multiple doctors to treat their ailments and there’s no coordination among providers.

“One may order a CT scan because of an incident and another specialist may order another one a year later,” Unterman said. “It’s just inefficient use of dollars.”

The cost heaped on the state system by these users attributes to why Georgia couldn’t afford the federal Medicaid expansion provided for in the Affordable Care Act.

The federal government offered to cover 100 percent of the cost of expansion for three years, but it would eventually drop to 90 percent. The aim was to cover more of the poor and uninsured under the program.

Changes to the program would be through policy, not legislation, and it’s something being worked on at the state level, she said.

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